- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,515.97 / $1,615.00 / $6,953.60
| Facility | | $1,515.97 | $1,615.00 | $6,953.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.71 / $518.28 / $35,600.00
| Facility | | $0.71 | $518.28 | $35,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,515.97 / $1,883.99 / $2,860.34
| Facility | | $1,515.97 | $1,883.99 | $2,860.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.00 / $661.00 / $4,877.00
| Facility | | $301.00 | $661.00 | $4,877.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $11,596.40 / $14,048.72
| Facility | | $55.00 | $11,596.40 | $14,048.72 |